Methamphetamine abuse increases the risk of adverse heart health effects

Methamphetamine abuse is associated with cardiovascular damage on a scale comparable to decades of alcohol and cocaine abuse, according to a recent study.

There was an increased risk of several forms of cardiovascular disease (CVD), including pulmonary hypertension (PH), heart failure (HF), stroke and myocardial infarction with obstructive coronary artery disease (MI), myocardial infarction with non-obstructive coronary arteries (MINOCA). , MI plus MINOCA and the total burden of CVD.

The study was conducted among a population of hospitalized patients in California reporting a history of use between 2005 and 2011 and published in Journal of the American Heart Association.

“Its harmful effect on the cardiovascular system is thought to be multifactorial; a combination of excessive catecholamine release leading to hypertension, tachycardia, and coronary vasospasm, as well as the direct cytotoxic effect of increased reactive oxygen species and mitochondrial damage to cardiac myocytes,” the authors wrote.

“Therefore, it is vital that we better understand the burden of disease associated with methamphetamine abuse and identify the key factors that lead to its development in order to identify prevention and treatment targets in this high-risk group.”

Study data were provided by the Healthcare Cost and Utilization Project database, among whose more than 20 million patients 0.3% reported methamphetamine use at a median (IQR) follow-up of 4.6 (3.0-6.4) years after receiving inpatient, emergency department, or outpatient surgery care and services.

Overall, 53% and 42% higher risks were evident in the study population for HF (HR, 1.53; 95% CI, 1.45-1.62) and PH (HR, 1.42; 95% CI, 1.45-1.62), respectively CI, 1.26-1.60). Specifically, among male study participants, the risk of MI was particularly elevated, at 73%, compared with female participants (HR, 1.73; 95% CI, 1.37-2.18).

Chronic kidney disease (CKD) (HR, 2.38; 95% CI, 1.74-3.25), PH (HR, 2.26; 95% CI, 2.03-2.51), diabetes (HR , 1.75; 95% CI, 1.55-1.97), smoking status (HR, 1.28; 95% CI, 1.17-1.40), and obesity (HR, 1.71; 95 % CI, 1.44-2.02) correlated with higher CVD risks among methamphetamine users compared to nonusers. Concomitant cocaine use, in particular, was associated with a higher risk of MI and/or MINOCA (HR, 1.45; 95% CI, 1.06-2.00).

The main factors associated with methamphetamine use relative to those not reporting methamphetamine use were mean (SD) younger age (33 [11.6] against 44.9 [19.5] years), male gender (63.3% vs. 44.4% of female patients), concomitant abuse of cocaine (0.33% vs. 0.12%) and alcohol (6.5% vs. 0.67%), history of smoking (26.1% vs. 3.8%), chronic depression (11.9% vs. 1.9%), chronic anxiety (4.7% vs. 1.5%), and income quartile (first quartile, 34 .20% vs. fourth quartile, 14.60%).

Furthermore, compared with those who did not report use of the following, the overall 32% increased risk of cardiovascular disease from methamphetamine use (HR, 1.32; 95% CI, 1.27-1.38) was comparable to 28% specifically reporting alcohol abuse (HR, 1.28; 95% CI, 1.26-1.31) or 47% reporting cocaine use (HR, 1.47; 95% CI, 1.40- 1.54), the study’s researchers emphasized. The trend of higher risk was also evident among the other CVD subtypes studied:

  • MI: 19% (HR, 1.19; 95% CI, 1.08-1.31)
  • MI or MINOCA: 10% (HR, 1.10; 95% CI, 1.01-1.21)
  • Stroke: 12% (HR, 1.12; 95% CI, 1.03-1.22)

In elucidating the clinical significance of their findings, the study authors highlight 3 areas that their results suggest are important to target: modifiable risk factors (eg, CKD, hypertension, diabetes), CVD treatment that improves outcomes , associated with PH and HF, and the interaction of CVD and psychiatric disorders.

“Recognizing the significant burden of methamphetamine-related CVD is vital given the rapidly increasing use of methamphetamine and related stimulants worldwide,” they concluded. “Further work is also needed to better understand the effects of dose, duration of use, and route of administration of methamphetamine on the cardiovascular system.”

reference

Curran L, Nah G, Marcus GM, Tseng Z, Crawford MH, Parikh NI. Clinical correlates and outcomes of methamphetamine-related cardiovascular disease in hospitalized patients in California. J Am Heart Assoc. Published online August 1, 2022. doi: 10.1161/JAHA.121.023663

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